Tech that assists those with speech impairments, telemedicine for mapping public health

June 8, 2017 | by

This year’s trend to develop technologies that solve specific but important problems, such as improving navigation for the visually impaired, [TTA 8 June] continues:

  • Voice-controlled assistance systems are becoming commonplace, from improved interactive voice response (IVR) to Siri, Echo, and Alexa. Their limitation is that their recognition systems understand only standard, not impaired or even heavily accented speech. For those with the latter, a Tel Aviv-based startup called Voiceitt has developed Talkitt, an app that learns an individual’s speech based on basic, everyday spoken (or typed input) phrases and after a training period, converts them into normal audio speech or text messages on a tablet or smartphone. This aids with everyday life as well as devices like Echo and Alexa. Voiceitt is out of the Dreamit Health accelerator and was just seed funded with $2 million. This Editor notes from the TechCrunch article that it’s described as ‘the thin edge of the wedge’ and ‘a market with need’. It will be introduced this year to health systems and schools to assist those with speech impairments due to health conditions. Hat tip to Editor Emeritus Steve Hards
  • Diagnosing degenerative diseases such as diabetic retinopathy, which is preventable but if untreated eventually blinds the patient, is doubly difficult when the patient is in a rural, economically disadvantaged, predominantly minority, and medically underserved area of the US. Ophthalmologist Seema Garg has been on a quest since 2009 to have this recognized as a public health threat. The North Carolina Diabetic Retinopathy Telemedicine Network out of University of North Carolina-Chapel Hill, headed by Dr. Garg, collaborated with five NC clinics to recruit patients with diabetes. Her team then trained primary care staff to take digital retinal photographs transmitted over a secure network to be examined for symptoms. The public health study used Geographic Information Systems (GIS)-mapping for patient accessibility to ophthalmologists, demographics, and risk factors such as higher A1C levels, minority race, older age, kidney disease, and stroke. JAMA Ophthalmology, Futurity  Hat tip to Toni Bunting of TASK Ltd. (and former TTA Ireland editor)

Iron Bow partners with Vivify Health for $258 million VA telehealth contract

February 15, 2017 | by

One mystery solved! Iron Bow Technologies announced that its telehealth delivery partner for their award of $258 million in the Veterans Affairs Home Telehealth program is Plano, Texas-based Vivify Health. As noted in our original article [TTA 6 Feb] on the much-delayed VA remote patient monitoring award, Iron Bow was an existing contractor in other VA Telehealth services, Clinical Video Telehealth (video conferencing) and Store-and-Forward (clinical imaging review), but did not have vital signs RPM capability. The addition of Vivify with its mobile and tablet-based solutions and integrated peripherals adds that capability.

Vivify structures its main telehealth solutions based on escalating patient ‘risk’: 1) healthy and ‘at risk’ (may have early stage disease), 2) rising risk (has complex chronic disease) and 3) high risk (for hospitalization). The approaches are scaled up from engagement on BYOD mobile and web for (1), to vital signs monitoring and telemedicine clinician visits via mobile and tablet (2), to the highest level of an integrated kit with tablet and integrated peripherals (3). These further divide into five ‘pathways’ which are more product-oriented.

Cost is, of course, a factor, with VA a very demanding client in this regard as individual VISN (region) budgets are tight. Medtronic, the incumbent, has not only been using the venerable Cardiocom Commander Flex hub, but also provides VA with Interactive Voice Monitoring (IVR) which is an inexpensive patient management solution. (Ed. note: having worked with IVR in the past, it can work well if used with primarily lower-risk patients, is structured/implemented properly and integrated with live clinical check-ins.) Vivify’s system is all new–and not inexpensive, especially at the high-risk level. From their website, Vivify uses BYOD for the lower levels and the integrated kit for the highest and poorer outcome patients. This Editor notes they offer a voice telephony care solution which presumably is IVR. This gives them a welcome flexibility in price, but also a complexity which will be a training issue with VA care coordinators.

Other factors affect mobile-based solutions. Many at risk at-home veterans are older and thus don’t have smartphones or tablets. Reliable broadband connectivity is also an issue. Many don’t have Wi-Fi, which is a prerequisite for tablet use, and may live in areas with poor cellular reception.

The other work and labor-intensive parts for Vivify and Iron Bow are to integrate their reporting platform into VA’s complex and secure systems, which also involves a highly structured updating process: CPRS (computerized patient record systems), the VistA EHR and whatever replaces it (Epic is being trialed in Boise, Idaho–scroll down to ‘Big Decisions’ and Dr Shulkin).

Founded in 2009, Vivify has compiled an impressive track record with CHRISTUS Health (TX), RWJ Health (NJ), Trinity Health (MI), Centura Health (CO) and other large systems plus home care. It has also been conservative in its venture funding, with $23.4 million to date and its last big round from LabCorp and others in 2014 (CrunchBase).

Release. Hat tip to Vivify’s Bill Paschall via LinkedIn.  P.S. Stay tuned for an announcement of 1Vision’s partner. 

Editor’s clarification: The VA Home Telehealth contract is structured as a one-year base period, followed by four one-year optional periods, for five years total. The awarded amount over the five-year period is $258 million for Iron Bow/Vivify. It is the same amount/term for each of the three other awarded companies, totaling just over $1 billion for the five-year program. This is comparable to the 2011 five-year program value of $1.3 billion divided over six awardees. Thanks to Josie Smoot of Iron Bow Technologies’ press office.

4 year telehealth study charts ~40 percent CHF readmissions reduction

October 9, 2014 | by

Finally an encouraging long-term, large N study on telehealth reducing same-cause hospital readmissions. Pennsylvania’s Geisinger Health Plan, the managed care arm of integrated health system Geisinger Health, has released findings from a four-year (2008-2012) study of 541 GHP Medicare Advantage beneficiaries with congestive heart failure. Hospital readmissions after 30 days were 44 percent lower and after 90 days 38 percent lower. Return on investment: “for every $1 spent to implement this program, there was approximately $3.30 return on this investment in terms of the cost savings accrued to GHP.”

Patients were assigned case managers and provided with a relatively simple program combining Bluetooth-connected weight scales and interactive voice response (IVR) calls to answer questions such as shortness of breath, swelling, appetite and on prescription medication management. The case managers used a platform to aggregate the data (more…)